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Arch Womens Ment Health. 2018 Dec;21(6):785-790. doi: 10.1007/s00737-018-0855-9. Epub 2018 Jun 4.

Antenatal depression, psychotropic medication use, and inflammation among pregnant women.

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Northwestern University Feinberg School of Medicine, 250 E Superior St, Suite 05-2191, Chicago, IL, 60611, USA.
Northwestern University Feinberg School of Medicine, 250 E Superior St, Suite 05-2191, Chicago, IL, 60611, USA.
Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
School of Education and Social Policy, Northwestern University Institute for Policy Research, Chicago, IL, USA.
University of California, Irvine, CA, USA.
Charité, Universitätsmedizin, Berlin, Germany.
Northwestern University, Institute for Policy Research, Evanston, IL, USA.
University of California, Irvine, Irvine, CA, USA.
Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, NorthShore University Health System, University of Chicago Pritzker School of Medicine, Chicago, IL, USA.


To evaluate the association between psychotropic medication and inflammatory biomarkers in women with antenatal depressive symptoms (ADS). In this cross-sectional secondary analysis of a prospective multicenter observational study, 723 pregnant women underwent a depression screen using the Center for Epidemiologic Studies Depression Scale (CES-D) between 12 and 21 weeks gestation. Self-reported use of medications for depression and/or anxiety was corroborated with the medical record to document exposure to pharmacotherapy. Serum was collected and inflammatory biomarkers (IFNγ, IL13, IL6, IL8, TNFα, CRP) were measured concomitantly. Women were included if they fell into one of three categories: ADS responsive to treatment (CES-D < 16 with medication), ADS not responsive to medication (CES-D ≥ 23 despite medication), and untreated ADS (CES-D ≥ 23 with no medication). Levels of inflammatory biomarkers were compared among groups and multivariable regressions performed. Of the 85 women studied, 16 (19%) had ADS responsive to treatment, 12 (14%) had ADS not responsive to medication, and 57 (67%) had untreated ADS. TNFα concentrations significantly differed (P = 0.016) across the cohorts. Post hoc bivariate analyses demonstrated that women with ADS responsive to treatment had lower serum TNFα than non-responders (p = 0.02) and women with untreated ADS (p = 0.01). There were no differences in IFNγ, IL13, IL6, IL8, or CRP among the groups. Regressions demonstrated that, compared to women with ADS responsive to treatment, non-responders or women with untreated ADS had higher TNFα levels (β = 0.27, 95% CI 0.02-0.52 and β = 0.23, 95% CI 0.02-0.44, respectively). Pregnant women on pharmacotherapy who respond to treatment for ADS have lower TNFα compared to women not responsive to medication or women with untreated ADS. These data suggest the possibility that either the therapeutic response in the context of pharmacotherapy is accompanied by modulation of the immune system or that pre-existing higher levels of TNFα may be associated with a poorer response to traditional pharmacotherapy.


Antenatal depression; Anti-depressants; Inflammation; Perinatal depression; Selective serotonin reuptake inhibitors

[Available on 2019-12-01]

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